Japan has an aging population. The median age is 49.5 years and the average life expectancy is 85, both about ten years older than the US average. These stats and numbers give rise to a very human dilemma: How do we, as a society, care for the elderly? Dementia 21 tackles that question in the form of an absurdist comedy manga that uses a blend of SF and horror to get its point across.
The main character (and one of the few consistent things in this off-the-wall series) is a young woman named Yukie Sakai who works as a care aide at an elder care company. Yukie is diligent, thoughtful, kind but always professional; she’s the type of care worker you’d want looking after your loved ones, or even yourself. Thanks to glowing customer feedback, Yukie is the top-rated employee at her company. This leads to her co-worker Ayase becoming jealous, and she in turn convinces their boss (whom Ayase is sleeping with) to give Yukie only the most dangerous/demanding clients. This is the framework to explain why Yukie ends up in one bizarre situation after another, but honestly you can forget about the setup pretty early on. There doesn’t need to be a reason for Yukie to end up in these wild scenarios; that’s just the job of an at-home care worker.
An early story, and one that maybe best exemplifies the themes of the series, has Yukie go to a home where three elderly ladies need care. As the client explains, his mother’s two sisters never married, and so his family took them all in. Yukie approaches the job with gusto, despite the challenge of having to do triple the work. On her second visit to the home, there are six elderly family members to care for (“My mother has three other sisters, you see …”[vol.1, p.22]). Yukie stays on top of things, only for the number of patients to double the next day, and the next. When Yukie calls the client to say it’s too much for her to care for thirty-plus old patients, he’s taken aback, saying there are only twelve old folks in his extended family. Yukie discovers that people have started abandoning their elderly family members at the house, expecting Yukie to care for them. The old folks are sanguine about their fate: “I only get in the way at home,” one of them says. “It’s better to be abandoned” (vol. 1, p. 23). Yukie rallies the people in the house, who now number in the hundreds, asking how they can stand to be thrown out like trash by their own families. Yukie’s words spark a flame of righteous anger in the assembled old folks, and they combine into one giant humanoid figure big enough to burst out of the house. The chapter ends with this newly forged giant shambling off with the collective intent of taking revenge on the families who had abandoned them (“We’ll show them the might of senior power!!” [vol. 1, p. 32]).
As outlandish as the dénouement is, this is one of the more down-to-earth stories in the series. I could spend hundreds of words recapping many of the high-concept ideas in Dementia 21. One story has Yukie dealing with a forgetful aging Ultraman proxy and keeping this massive superhero from destroying the city. One has her dealing with an elderly telepath with dementia: Every time the woman forgets a concept/person, her powerful abilities wipe it from existence. Another has Yukie trying to find a client in a foggy city, only to discover that aliens have turned Earth into a pachinko machine and the fog is from their cigarette smoke (that last one is from volume 2, in which some of the author’s ideas are a little less on-theme). There’s even a very Junji Ito-esque story with some mild body horror involving a high-tech pair of dentures.
Shintaro Kago’s main influence, though, is Katsuhiro Otomo. Otomo is best known for being the creator the sprawling manga epic Akira (1982-1990) and the landmark anime film based on it (1988). The similarities art-wise between the two creators is clear but doesn’t amount to a precise copy: There’s simply an eighties sensibility to Kago’s art, and like Otomo he balances the right mix of detail and minimalism to make the absurd seem almost mundane. Thematically, it’s clear that Kago takes a lot of cues from Otomo as well. While Otomo might be most widely known for Akira, in 1980 he created Domu: A Child’s Dream (1980-1981), a manga in which an elderly man and a young child living in the same apartment building use their psychic powers to wage war on one another. He also wrote the script to the 1991 anime film Roujin Z, in which an eighty-seven-year-old man’s robotic hospital bed turns into a giant mecha and kidnaps him in order to fulfill its prime directive of keeping him safe. The main character in Roujin Z is a young nurse in the same mold as Yukie, and the plot of Roujin Z could easily work as a chapter of Dementia 21.
Kago himself talks about his influences in an interview at the end of volume 1, but only just: It’s the type of interview where the questions are often longer than the answers, and most of Kago’s answers boil down to him declaring his desire to let the work speak for itself. While Kago clearly takes a lot of inspiration from the works of Otomo, the similarities between the two men’s works mostly show how the theme of elder care is something anime and manga have been dealing with for decades.
It is a toss-up in any given story whether the elderly characters will come off as plot devices or actual characters. The manga is hilarious and cuttingly insightful, but it is simultaneously juvenile, with jokes and humor that wouldn’t be out of place in Mad Magazine. Not every old man Yukie meets is a perv, but a lot of them are, and if off-color sex jokes put you off, then this might not be the series for you. The manga is at its best, though, when it shows that the elderly are no different from anyone else. My favorite story in the series involves a high-tech care home in which the elderly live in rooms the size and shape of small cargo containers. These box rooms have everything a person could need to live: toilet, shower, food, medical equipment. The boxes are then stacked on top of each other, creating towers that go higher than the clouds.
At first, it seems like this will be a story about automation and the dangers of outsourcing the job of looking after human beings to machines, but that’s not the case. Instead, it becomes a story about the society that the denizens of the boxes have formed amongst themselves. They use wires slung across the towers to trade goods and use the internet to communicate. They elect their own government, create a thriving black market, fall in love with each other, and form rivalries that escalate into people sending bombs to each other’s rooms. For all its outlandishness, the conflicts and machinations remind me a lot of the care home my Nan lives in, where securing a spot at the Friday three p.m. bridge game takes as much cunning and guile as a courtier trying to get ahead at seventeenth-century Versailles. It’s also a story that shows how, just because people might grow frail with age, they still remain people—with all the wants and needs that come with that.
Part of the manga’s humor hinges on a disdainful view of human nature. The characters are all mainly selfish and only concerned with themselves. Even Yukie, who often goes above and beyond for her clients, is shown to be doing so just to keep her top-rated spot at her company. There are other comics out there that have elderly main characters with a slightly kinder view of humanity—one of my favorites is BL Metamorphosis (2017-2020), a manga series in which a teen girl and an elderly woman form a friendship over their shared fandom of boys’ love (small point of disclosure: I work at the company that published BL Metamorphis but I did not work on the series). But Dementia 21 isn’t here to warm your heart: it’s to make you laugh and marvel at the absurdity of life.
Near the end of the series, Yukie changes sides: After being fired from her job, she is recruited by the government to help “reduce the surplus at the top of the population pyramid” (vol. 2, p. 244), which is exactly what it sounds like. The government has stealthily been making the country more hostile to old people in order to kill them off indirectly, by means as diverse as getting rid of elevators and escalators to including more mochi in meals to cause choking. Yukie is at first adamant that she would never take part in such a cruel system, but one panel later a pile of money changes her tune. This sets off all-out war between the generations, with various characters from previous stories coming back for the finale. But even after all that, there is no solution: Aging and the struggles that come with it are part of us indefinitely. Dementia 21 points out the absurdity of capitalism and social norms and bureaucracy, but also the hypocrisy of ageism: The lucky among us will get to grow old; to resent those who already are highlights humanity’s shortsightedness.